Chronic Care

There are many definitions of “chronic condition,” some more expansive than others. We characterize it as any condition that requires ongoing adjustments by the affected person and interactions with the health care system.

The prevalence is rising
2005 data showed that more than 133 million people, or almost half of all Americans, live with a chronic condition. 1 That number is projected to increase by more than one percent per year by 2030, resulting in an estimated population of 171 million requiring chronic disease management.

Management of multiple chronic conditions requires a transformation in health care
Almost half of all people with chronic illness have multiple conditions. As a result, many managed care and integrated delivery systems have taken a great interest in correcting the many deficiencies in current management of diseases such as diabetes, heart disease, depression, asthma and others.

Those deficiencies include:

Overcoming these deficiencies will require nothing less than a transformation of health care, from a system that is essentially reactive – responding mainly when a person is sick – to one that is proactive and focused on keeping a person as healthy as possible. To speed the transition, in 1998, Improving Chronic Illness Care created the Chronic Care Model, which summarizes the basic elements for improving care in health systems at the community, organization, practice and patient levels. Evidence on the effectiveness of the Chronic Care Model was summarized in 2009.